Combating National Malnutrition Issues Through Staple Food Fortification

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Combating National Malnutrition Issues Through Staple Food Fortification Combating national malnutrition issues through staple food fortification Combating national malnutrition issues through staple food fortification Executive summary Shortages in adequate vitamin and mineral intake have led to a rising opportunity to address these deficiencies, working with food incidence of ‘hidden hunger’, a phenomenon caused by a chronic lack manufacturers to integrate essential micronutrients into staple food of essential micronutrients in a person’s diet. Deficiencies in the products through fortification. Micronutrient fortification of staple vitamins and minerals essential for achieving good nutrition continue foods, such as wheat and maize flour, has even been shown to play a to plague countries across the globe, including developed nations, significant role in increasing productivity at work, and therefore where it has been shown that it is possible to be both overweight and stimulating the growth of a country’s economy.1 It also has the malnourished at the same time. Governments, organizations and potential to help make hidden hunger a problem of the past, enabling non-governmental organizations (NGOs) worldwide now have an millions of individuals worldwide to be healthier and able to thrive. October 2017 Page 1 Combating national malnutrition issues through staple food fortification The cost of malnutrition It is estimated that one third of the world’s population is undernourished, caused by a What is hidden hunger? physical or financial lack of access to a Hidden hunger is a phenomenon where a diet is lacking in essential balanced, healthy and nutritious diet. vitamins and minerals, causing the body to be malnourished. Hidden Inadequate nutrition can have a major, long- hunger is present in both developed and developing countries lasting impact on human physical health and worldwide, and its prevalence reflects in part the rise in calorie-rich, development, but also places a heavy burden on societies across the world. yet nutrient-poor, diets that do not meet nutritional requirements. This can seriously challenge a country’s economic growth. Figure 1: Prevalence of hidden hunger worldwide2 Magnitude of hidden hunger: Mild Prevalence of low urinary iodine (%) Moderate Severe 1 10 50 100 Alarmingly high No data People who do not consume a sufficient potential as a consequence of suboptimal five years of age showed stunted growth in proportion of micronutrients, particularly in nutritional intake, remain a major public 2012.6 Such conditions can increase the risk utero and as children, are more likely to face health concern in a number of developing of illness, but may also result in delayed cognitive and physical difficulties for the rest countries, including many in sub-Saharan mental and physical development, affecting of their lives. Conditions such as stunting, Africa and the Middle East.3,4,5 It is estimated school performance and productivity during reflected by a failure to reach linear growth that 162 million children worldwide under the working lives of individuals. Page 2 Combating national malnutrition issues through staple food fortification Figure 2: Global map of vitamin E status Figure 3: Global map of vitamin D deficiency in adults8 in healthy populations7 Indication of status: Blood vitamin D level: Desirable Deficiency > 75 nmol/L >30 micromol/l <12 micromol/l 50-74 nmol/L Inadequate Children up to 12 years 25-49 nmol/L 12-30 micromol/l < 25 nmol/L Figure 4: Prevalence of vitamin D deficiency in the Middle East9 . Kingdom of Kingdom Saudi Arabia . United . Arab Emirates Arab . Country . Egypt Elderly . Men Pregnant women Women of childbearing age Lebanon Adolescents Children Prevelance (%) of vitamin D deciency and insuciency (serum 25(OH)D <50 nmol/L) Page 3 Combating national malnutrition issues through staple food fortification Overweight and malnourished Changes in global dietary habits now mean that malnutrition is no longer a problem that exclusively affects those in developing countries with limited access to food. Reports estimate Why are micronutrients that there are two billion people worldwide living with hidden hunger, which can occur even important? 10 if a person is consuming a sufficient quantity of food. In fact, hidden hunger can, and often The vitamins and minerals does, arise in overweight or obese individuals in developed, westernized regions consuming found in nutrient-rich foods diets that are high in calories, but poor in nutrients, and processed foods. The result is that play an important role in our it is now possible to be both malnourished and overweight at the same time. Indeed, Gross Domestic Product (GDP) growth no longer guarantees an improvement in nutritional status. health and wellbeing. Deficiencies of micronutrients in the diet are linked to a Vitamin A is essential for vision Vitamin D, often known as the range of health concerns, as (particularly night vision), growth and ‘sunshine vitamin’, is a fat-soluble development, immune function and for essential nutrient, providing a number well as an increased risk of healthy male and female reproductive of health benefits. It is recognized for chronic diseases, such as organs. Being deficient in vitamin A is a its role in calcium absorption, which cardiovascular disease (CVD), leading cause of blindness, and can helps to support bone health. diabetes and obesity. contribute to high rates of childhood Deficiencies can contribute to rickets 11 mortality and serious birth defects. in children and osteoporosis in Aside from helping to improve the physical 12 adults. Vitamin D also plays an and mental health and development of important role in supporting immune individuals, good nutrition is also considered 13 Vitamin B12 is a water-soluble vitamin function and cardiovascular health. a key trigger in ending the ongoing vicious that plays an important role in the cycle of poverty that traps millions of people function of the brain and nervous in societies across the globe. The 2008 system, as well as the formation of red Vitamin E is an essential fat-soluble Copenhagen Consensus, a project that blood cells. Humans are incapable of antioxidant vitamin that is important in brought together a panel of world-leading 15 producing this vitamin, so must draw it supporting heart health. It helps to economists, concluded that improving from sources such as animal products, defend cell membranes from oxidative nutrition was one of the best, most cost- fortified food products and dietary damage or inflammation, which can effective development investments to 14 16 supplements. contribute to CVD. address the major challenges facing the planet today.22 Their forecasts and calculations suggested that: Vitamin C is a water-souble antioxidant that is present in many fruits, vegetables and • Spending US$ 60 million a year on dietary supplements, and helps to support immunity and the regeneration of other micronutrient provision could yield antioxidants, such as vitamin E.17 It can also help to achieve good cardiovascular health.18 benefits in terms of improved health, lower Severe vitamin C deficiencies can cause scurvy, which can cause bleeding gums and mortality and increased income pain in the muscles and joints. opportunities worth US$ 1 billion • An annual investment of US$ 19 million in Folic acid is often recommended during Iron performs a number of vital roles in food fortification could bring US$ 570 pregnancy to prevent neural tube the body, including the transportation million in similar benefits23 defects and support the health of red of oxygen to body tissues and red blood Investing in good nutrition to address 19 blood cells. Deficiency can contribute cell regeneration. A shortfall of iron is shortfalls in micronutrient intake clearly to tiredness, irritability and appetite one of the most common nutritional presents a significant opportunity to improve loss, while severe deficiencies can deficiencies in the world and can result health and wellbeing, optimize development cause anemia and, if in pregnant in anemia, which leads to fatigue, potential, and support the economic stability 20 21 women, can result in premature birth. shortness of breath and weakness. and growth of countries worldwide. Page 4 Combating national malnutrition issues through staple food fortification What is staple food fortification? Fortification is one of the most safe, effective staple food fortification is now mandatory, a out mandatory national-scale flour and affordable tools to enhance the movement that started to gain traction in the fortification, and several other countries in the nutritional value of staple food products 1970s and took off in the early 2000s as region, including Jordan and Iran, followed such as wheat, maize (corn), rice, vegetable more and more countries integrated it into shortly after.25 Wheat flour and maize flour oil and sugar. This process involves adding or their nutrition strategies. One of the earliest fortification has also been compulsory in South replacing essential vitamins and minerals regions to adopt was the Middle East where, Africa since 2003 and, in 2016, the Africa Maize that may have been lost during processing, in 1978, Saudi Arabia was amongst the first Fortification Strategy for 2017-2026 was and has become well recognized for its countries to implement wheat flour created, in an effort to upscale the region’s benefits to public health. In many countries, fortification.24 By 1996, Oman had also rolled maize flour fortification program.26 Page 5 Combating national malnutrition issues through staple food fortification What makes it so successful? Return on investment Acceptance The impressive uptake of staple food The widespread acceptance of staple food fortification can be owed to the fact it can be fortification can be attributed to a number of implemented without changing the dietary patterns of a population. Nor does it require factors: it is relatively easy to implement and conscious engagement or compliance from individuals – advances in technology mean that it it is cost-effective, meaning that is possible to fortify products, such as rice or flour, without any impact on sensory governments and food manufacturers can characteristics, like appearance and taste.
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